My experience with abscess&fistulas&loose seton

Hi all,I appreciated all the folks sharing their experiences here as I went through hard times with abscesses and fistula,so I wanted to thank and share my story,which hasn`t ended btw.I don`t have Chrons and I appreciate how hard of a situation they go through.I am a male of 31.

01/17
Have a fissure, because of travel and so on,it doesn`t heal up,I don`t even know what it is and afraid I am done for.Try all herbal remedies etc it doesn`t pass away.
03/17 Go to gastro specialist and show him up.He says fissure and tells me to drink prune juice for a few weeks and its all good.
05/17 Fissure doesn`t heal up and I get the cold twice in a row with fever,develop an abscess at the fissure location 12 o click.Go to saint joseph ER in toronto,they give the cat scan and they say it is too small and deep lets go for antibios for 3 weeks.
07/17 Antibios end, and the abscess starts growing bigger afterwards and upwards toward testicles.Go to general surgeon we shake hands on incision and drainage under full anesthesia a week later.(did I mention how slow is the canadian health system)The abscess grows too big,had to go to ER ,the surgeons drain it via local anesthesia after waiting for them 6 hours(after the doc at Er) and the abscess grows to the size of a lemon,went to nurse and confronted them to call the docs immediately!They come down finally and the student guy drains it.Daily packing for 15 days,painful yeah but ok gotta do whatever it needs to heal.

08/17 After it heals up and a week passes I feel the pressure and the symptoms of the abscess again,horrible horrible as you know.I start antibios just to function so I can visit hospitals etc.I go to gastro specialist downtown which is faster to see.He asks for ultrasound(and most of the places say it will take 3 weeks!)I found one which is in a week.I recieve the ultrasound,it says there is an abscess on the side in remission.I visit the same general surgeon at Saint joseph,I say look here you go,we have another.She says why did you come to me ,go to Er.I was *** ok write me a note then,so they don`t give me antibios again.I say screw saint joseph ,went to sunnybrook ER.There,I could hardly make them believe I have a problem,even with the note!.They give a full abs scan and pelvis scan.Negligence and crapty really,I learnt afterwards the abs scan, why are you giving me radiation to spleens and lungs.And I asked for an Mri,as Ultrasound results suggested for one.The doc says no and gives me whole body radiation.

Ok,the cat scans come back,and shows there is smtng going on which is not clear.(and asks for an MRI!)Finally the surgeons come down,young residents mind you,but one of them seems to have a good head on her head.She feels it up and finds the spot, says ok there probably is a fistula there.I say it builds up and turns into an abscess.Doesnt believe me as usual.At this point I understand they wont do jack,I prepare a list of surgeons to be referred to.They come back and say there is no urgency and I say, give me antibios and refer me to Ted Ross then.They say ok Ted will accept you and there is no long wait list and refer me,I say ok at least I will see someone who knows what they are doing.This trip to ER cost 3000 dollars.

Never recieve a call from Ted ross,can not reach him in his offices for 2 weeks,phones doesn`t get picked up daily and many times.I say f. this.

Arrange my affairs,and go back to my home country Turkey.

Get an Mri for 100 dollars in the same day,shows there is an abscess.I go to a private hospital next day and drain it up in general anesthesia which costs 400 dollars in total compared to canadian ER entry fee 800 dollars.I say look for fistulas too,the surgeon say there is none.

End of 08/17:
As this time was just drainage,it closes up in a few days and the pain comes back in a few days too.I say ok time for new MRI.Go and have a new one,which shows a,makes intersyphincther fistula.Find a better experienced phd general surgeon.He says before the MR result you have a fistula there we gotta do a fistulotomy and a big lay open of the area so it heals inside out as it`s intershypinctheric fistulotomy I am ok with it.I say ok,come out of surgery.He says it was great, I saw the abscess lobes twice on the path,which is layed open.Fissure is also handled.

Have a crater of a wound,afraid to look it up first week.Daily packing and baticon treatment which makes me scream three times a day for 20 days,head spinning pain no joke.And the wound heals up in a month and a half.

10/17:
Start getting the abscess cramps again.Find a different MR machine,(they are pretty much all 1.5 tesla but this center used twice the dose of intrevenous dye)This time got a better view!There is a transshypnctheric fistula and it divides to two after the external sphyncther.I talk with my last General surgeon he say darn,this will go seton path and puts me on antibios for two weeks so he can cut less when the the time comes.Antibios keeps things under control without any pain medication.

I start reading hardcore on pubmed etc.Learn all about fistula treatments.I find two surgeons who uses Vaaft and laser combined and only do proctology cases.As my last surgeon doesn`t have vaaft and gonna cut more shyphcter I see both of them.Of them says nah,vaaft is not suitable that track is mushy right now I will laser that up under local aneshesia.I say, we have a side track(10 o clock) on the MR what you gonna do about it?He says nothing,I will go through the main path 12 o clock.I am not satisfied as 10 o clock is hurting for the last 6 months and I think it needs to be addressed.

Go to the other proffessor surgeon in istanbul,which is highest-end.He looks at the history,and says,this is reoccurent abscess right now,we have to put the seton for 6 months,after then we can laser this up.He says I will vaaft this,I don`t trust MR s and I will give you a colonoscopy.He says you never do fistulotomy and cut the muscle,I only recieve the hardest cases which comes to me after a few unsuccesfull operations.I say perfect,and go under.

Colonoscopy comes clean.He says he couldnt see any side ways and its pretty simple direct 12 o clock trans fistula and puts in the loose seton.Says go off antibios.I am kinda worried that 10 o clock will give problems soon.

First 3 days:
Mediocre pain,3x diclofenac daily cancels it out almost totally.Seton is longer on the outside than I thought,but don`t feel it,not a big problem aside from the cosmetics.

4th day:

Pain starts building up and pressure as usual on 10 o clock.darn,horrible feelings come down as usual with abscess symptoms.I double the pain medication 3x parasetamol 500mg and 3x diclofenac.It is the first time I used this much pain killers in my life.The surgeon calls me,I say, there is party going down there again doc,hard to pee etc..He says its expected continue on with salt batz and similar stuff and he will see me in a week.Pressure builds up in the day and then goes off for a few hours and then builds up again.

5th day today 24/10/17:
I keep on with doubled pain med,even then it hurts to sit.Bm doesnt hurt really,this pain is almost unrelated to that.

Best bet:things are getting sorted down there due to seton and inflamation is gonna open up to the seton track and the 10 o clock will heal up.

Worst bet:He skipped the 10 o clock track after the external sphyincther and there is really a abscess like collection building up there which would need additional operation.Hopefully what makes sense to me is that just laying that part open would suffice as it is after the sphyncters.

I will wait a few days to see how it shapes up as there is no collection can be seen from the outside and I know the doc will try to wait it out.In a few days,if things dont ease up,and if he tells nah its usual,i will get an endo-anal 3d ultrasonography which can be better viewing for trans fistulas,and I am thinking there is a room for abscess there we need to address.

I am also going off carbs and keto not to build anymore inflamation.

Whew!It really is a drag.Especially seeing and feeling the health system in place is for jack and you are not cared upon and docs try to refer and forget you.I couldn`t believe the canadian health system bounces people from ER to family doctor and back.It was not possible to see the docs I wanted even with paying for it.They are full.

So as an addiotional info,you can get a vaaft operation in turkey from a professor general surgeon who has learnt vaaft directly from the inventors themselves for around 6 grand including hospital stay of 1 day.

Thanks Dimitri,I wish you the best as well!

Laser and Vaaft is the way to go on this first as far as I could research as well.Vaaft is not fda approved in usa as I heard and europe seems to be ahead in the techs so we are lucky in that regard.Turkey has lots of surgeons who chooses laser first now as well.

My fistula sounds pretty much like yours,secondary dead-end extension outside the sphincthers and it hurts there touching and now by-itself as well.I am worried it will make additional extensions and complications.

Could you tell me if there was a build up of pressure and lots of pain on the secondary extension direction in the first/second week,and if it subsized later on?It`s pulsating pain right now even on 2 painkillers.

Appreciated Dimitri!Wish you a happy end to your adventure tomorrow)

I have almost no drainage from the seton channel,just a bit of wetness around it.Anywhoo,continuing with the sit batz 5 times a day.

I will see the surgeon tomorrow,he said come let me have a look.I am thinking an abscess is there,as an old ultrasound showed one at that location,but again it`s always an hassle:Finding exactly what is wrong and finding the right approach and taking action in the right time.Gotta find out what is wrong now.

Memmem, interesting stuff again.
I 've researched the loose seton "migration" issue a lot. It is true that the loose seton can migrate particulalrly if it is silk, but the elastic can do the same (to a lesser extent).
That's a good thing obviously, because it may leave you with a very minor surgery to cut the fistula in the end. In that case a fistulotomy may have no risk since the fistula can become very superficial.
Coupled with the lack of abscess news, It's good for you my friend.

Hey Dimitri,thanks for sharing that man..I hope so too,my surgeon saw the migration and was ok with it.

I find more and more that cutting carbs affect my pain levels.My pain levels are lower(no painkillers) to higher when I eat some carbs/sugar.I believe there is a connection right there as I am experimenting and seing now.The dietitians tell that carb burning causes inflamation in the body more and more so there is that too.

Hey Stevo,thanks and hope you recover totally as soon as possible too!

The thing is my fistula is and was a simple one,12 o clock direct exit at 12 o clock without any sideways it seems like now.The last surgeon remarked that after seeing with vaaft that if I saw him first there would be no need for seton.Even with a simple case it takes this long and a lot of people go through this as I read it,most people become experts.

It`s just that abscess and fistula issues are handled in the health system with such variety with no-competence to low-competence and this scala goes all around.None of the general surgeons in Canada suspected a fistula with a reoccurant abscess which is quite impressive and none of them asked a Mri.Almost 4 months lost there.Experienced ones can tell the fistula with their fingers.

ER isnt the place for fistulas.They write antibios and dont take action until there is an abscess that they can see.And honestly,I saw doctors talk with a patient with a fractured arm (long time ago)and recovering young guy for half an hour talking to him.It`s visible and clear cut.But with this stuff they don`t spend more than a few minutes.It was a shame the general surgeons I saw was less knowledgeable than me at this point.The history of the area is as important as the symptoms and doc`s are wired not to trust the patient..I am a healthy and strong looking guy and you get minus points for this in this matter believe it or not as they start to think it`s all psych-somatic and not believe there is anything wrong with you.Only the experienced ones asks for the whole history.If you don`t take ER road and the health system is slow you gotta use antibios so you make until your next visit to the surgeon`s and then it`s harder to convince him to look for root causes as that much time passed and nothing happened.

It is such a hard thing to make your way out of it.

-To Diagnose is a problem in itself:Even the MRI s are not conclusive(..not mentioning cat scans and external ultrasounds) and takes money&time to get even one of them.I saw three different MRI results for the same time here in Turkey as it`s cheap and widely available,which showed nothing/intersphyctheric/transsphynctheric depending on which place.It depends on the machine and the radiologist.And even getting one depends on convincing doctors/your persuasion skills to tell them the right words so they ask for it/ if you don`t get it privately.Or you get the antibiotics per default.My last proctologist surgeon told me he saw people on antibios for 6 months for these issues and told me even doctors themselves use it for so long and come to him for a solution..

Some of the doctors know the shortcomings of MRIs now,(only a fraction of them) and asks for endoanal ultrasound and there are even less radiologists that does those.As a patient,you learn about all this with trial and error.The top proctologist here said he doesnt even ask for MRIs.

-Its hard to navigate during it.If you dont use antibios the abscess/fistula get worse and you develop new problems,if you use the antibios you don`t have symptoms anymore.And good luck convincing doctors without a fever..Half of them won`t acknowledge that antibios suppress these issues too,its like twilight zone..

If you want the MRI s to show whats wrong you gotta get off antibios so the contrast is held in the viewing.But then how long?You are left to trial and error.

-These issues system wise falls under the domain of general surgeons and not colorectal surgeons which might have been better if it was the other way.

-The laser/vaaft is almost the best way to go on this(depending of course) but it`s not accepted as the default approach.Training is needed for it so not a lot of surgeons know it.


Anyway rant over,but there should be pamplets handed to the patients to make a concious decision on this.

Post Edited (Memmem) : 10/28/2017 3:08:44 PM (GMT-6)

Memmem that's fantastic news!
I have tried the non-sugar diets but they don't work for me. I eat minimal sugar anyway...
Your seton adjustment seems perfect and the fistula itself very small. Maybe you can have a fistulotomy.
All the best.